The RHINASTHMA GAV scores without SLIT, at the beginning and at the end of seasonal SLIT.

Background: The impact of treatments for allergic rhinitis on health-related quality of life (HRQL) becomes more and more important in the view of patients, physicians and payers, but not much is known about the effect of sublingual immunotherapy (SLIT) on this outcome parameter. Methods: In a prospective observational study, health-related quality of life was assessed with the German adapted version of a new specific questionnaire (RHINASTHMA GAV) in patients with allergic rhinitis with or without mild to moderate asthma due to grass, cereal, and/or rye pollen who were treated with seasonal high-dose SLIT with standardized allergen extracts. Results: 358 patients aged 5 - 68 years, mean ± SD disease duration of 8.8 ± 9.2 years were evaluated. During SLIT, the mean total score and all 5 mean sub-scale scores were substantially reduced by 36% to 55%. Subgroup analyses did not reveal any clinically relevant deviations from the results in the total study population. At the end of SLIT, mean total score and sub-scale scores were virtually identical to those scores assessed during the validation procedure of RHINASTHMA GAV in healthy subjects without rhinitis, conjunctivitis, or asthma. These improvements in HRQL during SLIT were paralleled by substantially reduced disease-related burden, in terms of symptom scores and health-related impairment in daily life and at work. Conclusion: The improvement in HRQL during seasonal SLIT was clinically relevant and reached scores close to normal already in the first pollen season.

Assessment of the antiobstructive effect of fexofenadine on nasal allergy challenge in patients with seasonal allergic rhinitis.

The oral administration of fexofenadine 120 mg daily is a common treatment of seasonal allergic rhi-nitis (SAR). It reduces the H1 receptor-mediated symptoms, such as sneezing, pruritus, and nasal secretion as well as non-nasal symptoms such as conjunctivitis. The objective was to assess the effect of fexofenadine on nasal symptoms (such as nasal obstruction) in seasonal allergic rhinitis. A placebo-controlled, double-blind, randomized, cross-over study was performed which yielded evidence that two-week therapy with fexofenadine 120 mg daily in patients with SAR also relieves nasal obstruction and congestion. The parameters of nasal obstruction were eva-luated by means of rhinoscopy, a subjective symptom score, and active anterior rhinomanometry. The subjective evaluation of nasal obstruction/congestion as recorded by the patient every 15 minutes for 4.5 hours after nasal al-lergen provocation showed a significant difference of the AUC (p = 0.025) between fexofenadine and placebo with a 12.8 % lower obstruction after fexofenadine. The swelling of the nasal mucosa, which was assessed by rhinosco-py for 4.5 hours after nasal allergen provocation, was 21% lower after treatment with fexofenadine (p = 0.041). In this double-blind, placebo-controlled trial, subjective patient ratings as well as objective investigator assessments demonstrate the anti-obstructive effect of fexofenadine in nasal allergen challenge.